Medication-Assisted Treatment and HIV/AIDS: Aspects in Treating HIV- Infected Drug Users.
|
|
- Gavin Terry
- 5 years ago
- Views:
Transcription
1 Slide #1 Medication-Assisted Treatment and HIV/AIDS: Aspects in Treating HIV- Infected Drug Users. R. Douglas Bruce, MD, MA, MSc Assistant Professor Yale AIDS Program Medical Director South Central Rehabilitation Center (An Integrated Healthcare Center for Drug Users) Cornell Scott-Hill Health Center
2 NIH Consensus on Drug Treatment Slide #2 Drug addiction is a disorder of the brain and therefore a medical disorder Broader access to drug treatment Reduce federal and state barriers impeding access to treatment Stressed the importance of providing substance abuse counseling, psychosocial therapies, and other supportive services
3 Summary Slide Slide #3 Just as medication can help with depression, medication can help in the treatment of alcohol dependence, opioid dependence, cocaine dependence, nicotine dependence, etc.
4 Slide #4 Neurotoxicity NEUROTOXICITY AIDS, Cancer AIDS Mental illness CANCER MENTAL ILLNESS Homelessness Crime Violence March 10, Health care Productivity Accidents
5 Slide #5 If the societal cost is so high, why do people do drugs?
6 Addiction Slide #6 A state in which an organism engages in compulsive behavior The behavior is reinforcing (that is, pleasurable or rewarding) There is a loss of control in limiting the intake of the substance
7 Slide #7 Why Do People Take Drugs in The First Place? To feel good To have novel: feelings sensations experiences AND to share them To feel better To lessen: anxiety worries fears depression hopelessness
8 Slide #8 Vulnerability Why do some people become addicted while others do not?
9 Slide #9 Biology/genes Biology/ Environment Interactions Environment
10 High DA receptor Low DA receptor DA Receptors and the Response to Methylphenidate (MP) high low Dopamine receptor level Slide #10 As a group, subjects with low receptor levels found MP pleasant while those with high levels found MP unpleasant Adapted from Volkow et al., Am. J. Psychiatry, 1999.
11 DA D2 Receptor Availability Control Addicted Slide #11 Dopamine D2 Receptors are Lower in Addiction Cocaine DA DA DA DA DA DA DA DA DA DA DA DA Meth Reward Circuits Non-Drug Abuser Alcohol DA DA DA DA DA DA Heroin March 10, Reward Circuits Drug Abuser
12 Slide #12 Drugs Are Usurping Brain Circuits and Motivational Priorities
13 Slide #13 This is why addicts can t just quit This is why treatment is essential
14 Slide #14 Treatment for Addiction Includes: 1. Pharmacological (medications) 2. Behavioral Therapies 3. Medical treatment for the complications of addiction (e.g., HIV, HCV therapy) 4. Social Services
15 Slide #15 Pharmacology in Primary Care: Opioids = Buprenorphine
16 Heroin Slide #16 Heroin is a short-acting, semisynthetic opioid produced from opium that can be smoked, sniffed, or injected. Heroin euphoria begins shortly after injection and lasts ~ 1 hour, followed by 1-4 hours of sedation; withdrawal symptoms or craving begin several hours later. Most heroin dependent individuals inject 2-4 times per day. Many mediate sedating effects by injecting a small amount of cocaine, if available (not in Russia or Asia), known as a "speedball." Sometimes crack is smoked as a substitute. Unsterile use, unpredictable concentrations in street samples, adulterants in injection mixture, lifestyle necessary to procure drugs are responsible for most heroin-associated medical complications.
17 Effects of Buprenorphine Dose on µ-opioid Receptor Availability in a Representative Subject Slide #17 Binding Potential (Bmax/Kd) MRI 4 - Bup 00 mg Bup 02 mg 0 - Bup 16 mg Bup 32 mg Slide Courtesy of Laura McNicholas, MD, PhD
18 Medication Assisted Treatment - Opioids Slide #18 Rationale Cross-tolerance prevent withdrawal relieve craving for opioids Narcotic blockade block or attenuate euphoric effect of exogenous opioids Pharmacotherapy Buprenorphine Methadone LAAM Naltrexone
19 Intrinsic Activity Slide # Intrinsic Activity Log Dose of Opioid Full Agonist (Methadone) Partial Agonist (Buprenorphine) Antagonist (Naltrexone)
20 Buprenorphine, Methadone, LAAM: Treatment Retention Slide # Percent Retained % Hi Meth 58% Bup 53% LAAM 20% Lo Meth Study Week
21 Buprenorphine, Methadone, LAAM: Opioid Urine Results Slide #21 Mean % Negative All Subjects 49% 40% 39% 19% LAAM Bup Hi Meth Lo Meth Study Week
22 Buprenorphine Slide #22 Every physician treating HIV-infected drug users should have an X waiver and be ready to prescribe. The 1, 2, 3 of BUP: 1. It is easier than HIV/HCV treatment. 2. It is safer than prescribing oxycodone for pain or alprazolam for anxiety. 3. It is desperately needed to expand access to treatment.
23 Slide #23 Pharmacology in Primary Care: Cocaine = Disulfiram
24 Cocaine Slide #24 Cocaine hydrochloride is a water-soluble salt which is injected or taken by nasal inhalation, snorted. Although cocaine hydrochloride is destroyed by heat, it may be chemically converted to a free-base ("crack") cocaine, which can be smoked. Pulmonary absorption of crack is as rapid as IV injection. Cocaine s half-life is short, resulting in the need for frequent administration; active cocaine users may inject or inhale cocaine as many as 20 times a day. Cocaine induces feelings of elation, omnipotence and invincibility and with volatile behavior and rapid development of dependence. Cocaine use is associated with high risk sexual behavior.
25 Site of Cocaine Binding Slide #25
26 Disulfiram Slide #26 Increases dopamine in the brain by inhibiting dopamine beta hydroxylase. 6 RCTs have demonstrated efficacy in treating cocaine dependence. Dosage: 250 mg/day No studies in HIV/HCV populations so need to watch AST/ALT Problem remains adherence. Works well with the motivated patient or the patient who is administered it with methadone.
27 Slide #27 Pharmacology in Primary Care: Methamphetamine = Buproprion
28 Methamphetamine (MA) MA is a psychostimulant similar in chemical structure to amphetamine with more profound effects on the CNS and can be smoked, snorted, injected, or administered rectally. Produces stimulation and feelings of euphoria and has a long duration of action (6 to 8 hours after a single dose) Tolerance develops rapidly and escalation of dose and frequency is required. As with cocaine, MA use is associated with high risk sexual behavior (especially in MSM) Neurocognitive effects of MA use worse in HIV positive patients.. Slide #28
29 Slide #29 Dopamine Transporters in Methamphetamine Abusers Dopamine Transporter Bmax/Kd Time Gait (seconds) Motor Task Loss of dopamine transporters in the meth abusers may result in slowing of motor reactions. Memory task Loss of dopamine transporters in the meth abusers may result in memory impairment. 6 Delayed Recall (words remembered) Volkow et al., Am. J. Psychiatry, Normal Control Methamphetamine Abuser
30 Treatments Slide #30 Bupropion 150 mg twice daily has shown some reduction in use among mild methamphetamine users (Shoptaw, DAD. 2008) Counseling remains the mainstay
31 Slide #31 Pharmacology in Primary Care: Alcohol = Naltrexone
32 Alcohol Main Points Slide #32 Disinhibition that leads to increased risktaking behaviors and poor adherence to all treatments Withdrawal seizures The drug that really is frightening because it is neurotoxic and accelerates HCV disease progression CAGE Questions
33 ETOH Treatment Slide #33 Naltrexone FDA approved and standard of care Watch for hepatotoxicity (black box warning) Dosages: 100 mg per day (based on COMBINE study) Acamprosate FDA approved, but inferior to naltrexone Disulfiram FDA approved, but inferior to naltrexone
34 Topiramate Slide #34 Not FDA approved for ETOH dependence 8 papers showing efficacy of topiramate for ETOH dependence Doses varied by trial, but typically patients were started low (25 mg daily) and titrated up to a max of 300 mg over 6 weeks. Important choice because: 1.Can give to patients on opioids 2.Moderates symptoms of withdrawal
35 Slide #35 Pharmacology in Primary Care: Nicotine = Nicotine
36 The 5 A s Slide #36 Ask about tobacco use Advise smokers to quit Assess willingness to quit Assist with quitting Arrange follow-up Brief advice to quit does make a difference!
37 Pharmacotherapy Slide #37 Nicotine replacement helps Buproprion doubles quit rates (but is metabolized by CYP 2B6 so possible interactions with NFV, RTV, and EFV). Doses 150 mg to 300 mg effective. Varenicline better than buproprion and nicotine in comparison trials watch for suicidality and exacerbation of neuropsychiatric symptoms. Slow upward titration to minimize side effects.
38 Slide #38 Continuum of Interventions Knowing the Pieces
39 Range of Treatments Slide #39 Risk (Harm) Reduction Decrease frequency of adverse events related to a behavior Change in use behavior e.g., Changing from injection use to sniffing Risk (Harm) Removal Cessation of substance abuse Abstinence based 12 Steps Agonist based buprenorphine, methadone
40 Slide #40 Harm reduction is critical because drug addiction is a chronic illness with relapse rates similar to those of hypertension, diabetes, and asthma McLellan et al., JAMA, 2000.
41 Relapse Rates Are Similar for Drug Addiction & Other Chronic Illnesses Drug Addiction Type I Diabetes Hypertension Asthma Slide #41 Percent of Patients Who Relapse 40 to 60% 40 to 60% 30 to 50% 30 to 50% 50 to 70% 50 to 70% 50 to 70% 50 to 70% McLellan et al., JAMA, 2000.
42 Slide #42 There is a right way and a wrong way to Measure the Outcome of Treating Chronic Illnesses like Addiction Hypertension Tx YES Addiction Tx NO Stage of Tx Stage of Tx
43 DAT Recovery with prolonged abstinence from methamphetamine [C-11]d-threo-methylphenidate Normal Control high Slide #43 There is hope!! Methamphetamine Abuser (1 month detoxification) low Methamphetamine Abuser (14 month abstinent) Volkow et al., J. Neuroscience, 2001.
44 Slide #44 Questions?
Medical Interventions for Addiction in Primary Care Settings. R. Douglas Bruce, MD, MA, MSc Assistant Professor Yale University School of Medicine
Medical Interventions for Addiction in Primary Care Settings R. Douglas Bruce, MD, MA, MSc Assistant Professor Yale University School of Medicine March 23, 2010 NIH Consensus on Drug Treatment Drug Addiction
More informationOpioid Withdrawal, Opioid Substitution, and HIV Infection
Opioid Withdrawal, Opioid Substitution, and HIV Infection R. Douglas Bruce, MD, MA, MS Associate Clinical Professor of Medicine Yale University New Haven, Connecticut Learning Objectives After attending
More informationOpioid Withdrawal, Opioid Substitution, and HIV Infection
Opioid Withdrawal, Opioid Substitution, and HIV Infection R. Douglas Bruce, MD, MA, MS Associate Clinical Professor of Medicine Yale University New Haven, Connecticut Learning Objectives After attending
More informationOpioid Withdrawal, Opioid Substitution Treatment, and HIV Infection
Opioid Withdrawal, Opioid Substitution Treatment, and HIV Infection R. Douglas Bruce, MD, MA, MS Associate Clinical Professor of Medicine Yale University Chief of Medicine Cornell Scott-Hill Health Center
More informationUnderstanding Addiction and Its Impact on the Brain. SDSMA Webinar Matthew Stanley, DO
Understanding Addiction and Its Impact on the Brain SDSMA Webinar Matthew Stanley, DO Estimated Economic Cost to Society Due to Substance Abuse and Addiction: Illegal drugs: Alcohol: Tobacco: $181 billion/year
More informationTHE MEDICAL MODEL: ADDICTION IS A BRAIN DISEASE. Judith Martin, MD Medical Director of Substance Use Services San Francisco Dept.
THE MEDICAL MODEL: ADDICTION IS A BRAIN DISEASE Judith Martin, MD Medical Director of Substance Use Services San Francisco Dept. Public Health disclosures Dr. Martin has no conflict of interest to disclose.
More informationTHE STATE OF MEDICINE IN ADDICTION RECOVERY
OVERVIEW: Review addiction stats and trends Define addiction Explain neurobiology of addiction Review treatments of addiction Addiction Definition: A Primary, chronic, relapsing disease of brain reward,
More informationOpioids Research to Practice
Opioids Research to Practice CRIT Program May 2009 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin
More informationBiological Addictions Treatment. Psychology 470. Many Types of Approaches
Many Types of Approaches Biological Addictions Treatment Psychology 470 Introduction to Chemical Additions Steven E. Meier, Ph.D. Listen to the audio lecture while viewing these slides Detoxification approaches
More informationMedications in the Treatment of Opioid Use Disorder: Methadone and Buprenorphine What Really Are They?
Medications in the Treatment of Opioid Use Disorder: Methadone and Buprenorphine What Really Are They? Yngvild Olsen, MD, MPH Cecil County Board of Health Workgroup Meeting Elkton, MD October 8, 2013 Objectives
More informationPrepared by: Dr. Elizabeth Woodward, University of Toronto Resident in Psychiatry
Prepared by: Dr. Elizabeth Woodward, University of Toronto Resident in Psychiatry In broad terms, substance use disorders occur when a substance is used in a compulsive manner with a lack of control over
More informationMedication-Assisted Treatment. What Is It and Why Do We Use It?
Medication-Assisted Treatment What Is It and Why Do We Use It? What is addiction, really? o The four C s of addiction: Craving. Loss of Control of amount or frequency of use. Compulsion to use. Use despite
More informationUpdate on Medications for Tobacco Cessation
Update on Medications for Tobacco Cessation Marc Fishman MD Johns Hopkins University Dept of Psychiatry Maryland Treatment Centers Baltimore MD MDQuit Best Practices Conference Jan 2013 Nicotine Addiction
More informationOpioids Research to Practice
Opioids Research to Practice CRIT Program May 2008 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin
More informationThe future of pharmacological treatment.
The future of pharmacological treatment. Anne Lingford-Hughes Professor of Addiction Biology, Imperial College. Hon Consultant CNWL NHS Foundation Trust. What substances and when? What Nicotine Alcohol
More informationSW OREGON OPIOID SUMMIT. Medication Assisted Recovery for Opioid Use Disorder. Gregory S. Brigham, Ph.D. Adapt / SouthRiver CHC / Compass
SW OREGON OPIOID SUMMIT Medication Assisted Recovery for Opioid Use Disorder Gregory S. Brigham, Ph.D. Adapt / SouthRiver CHC / Compass Opioid Agonists Mu (μ) receptors stimulated by opioids causing full
More informationPharmacotherapy for opioid addiction. Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco
Pharmacotherapy for opioid addiction Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco Disclosure slide No commercial conflicts to disclose. Gaps in current treatment of opioid
More informationNIDA Principles of Treatment. NIDA Principles of Treatment. Peter Banys, M.D., M.Sc. No single treatment is appropriate for all individuals.
NIDA Principles of Treatment Peter Banys, M.D., M.Sc. CSAM Addiction Medicine Review Course San Francisco October 5 th, 2006 NIDA Principles of Treatment 1. Treatment Matching 2. Availability 3. Domains
More informationAddressing Opiate Abuse
Addressing Opiate Abuse William B. Lawson, MD, PhD, DLFAPA Associate Dean of Health Disparities University of Texas at Austin Dell Medical School william.lawson@austin.utexas.edu Opioids Medications that
More informationMedication Assisted Treatment for Opioid Use Disorders and Veteran Populations
Medication Assisted Treatment for Opioid Use Disorders and Veteran Populations Kamala Greene Genece, Ph.D. VP, Clinical Director Phoenix Houses of New York Benjamin R. Nordstrom, M.D., Ph.D. President
More informationEffective Treatments for Tobacco Dependence
Effective Treatments for Tobacco Dependence Abigail Halperin MD, MPH Director, University of Washington Tobacco Studies Program Ken Wassum Associate Director of Clinical Development and Support Quit for
More informationTreatment Approaches for Drug Addiction
Treatment Approaches for Drug Addiction NOTE: This fact sheet discusses research findings on effective treatment approaches for drug abuse and addiction. If you re seeking treatment, you can call the Substance
More informationOpioid Overdose Epidemic A Crises and Opportunity
Opioid Overdose Epidemic A Crises and Opportunity Samuel M. Silverman MD, FAPA, DFASAM Assistant Clinical Professor, UConn Medical School Director, Medical Education Rushford, A Hartford HealthCare Partner
More informationThaddeus Ulzen MD FRCP(C)FAPA FCGP Professor & Chair, Department of Psychiatry and Behavioral Medicine, Associate Dean for Academic Affairs
Thaddeus Ulzen MD FRCP(C)FAPA FCGP Professor & Chair, Department of Psychiatry and Behavioral Medicine, Associate Dean for Academic Affairs CCHS/University of Alabama School of Medicine Assessment History
More informationPage 1. Pharmacologic Interventions for. Addictions. Objectives for This Talk. Outline for This Talk
Pharmacologic Interventions for Addictions Eric C. Strain, M.D. Johns Hopkins University School of Medicine, Baltimore, Maryland Maryland Psychiatric Society November 7, 2015 Objectives for This Talk I.
More informationPharmacologic Interventions for. Addictions
Pharmacologic Interventions for Addictions Eric C. Strain, M.D. Johns Hopkins University School of Medicine, Baltimore, Maryland Maryland Psychiatric Society November 7, 2015 Objectives for This Talk I.
More informationMedical Assisted Treatment. Dr. Michael Baldinger Medical Director Haymarket Center Harborview Recovery Center
Medical Assisted Treatment Dr. Michael Baldinger Medical Director Haymarket Center Harborview Recovery Center Current Trends Prescription Drug Abuse/Addiction Non-medical use of prescription pain killers
More informationThe Chronic Disease of Addiction Evidence and Lessons from Practice
The Chronic Disease of Addiction Evidence and Lessons from Practice Laura G. Kehoe, MD, MPH Medical Director, MGH Substance Use Disorders Unit Bridge Clinic Massachusetts General Hospital Assistant Professor
More informationOpioids Research to Practice
Opioids Research to Practice CRIT Program May 2010 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin
More informationNational Institute on Drug Abuse (NIDA) Understanding Drug Abuse and Addiction: What Science Says
National Institute on Drug Abuse (NIDA) Understanding Drug Abuse and Addiction: What Science Says Last Updated February 2016 https://www.drugabuse.gov 1 Table of Contents Understanding Drug Abuse and Addiction:
More informationOpiate Use Disorder and Opiate Overdose
Opiate Use Disorder and Opiate Overdose Irene Ortiz, MD Medical Director Molina Healthcare of New Mexico and South Carolina Clinical Professor University of New Mexico School of Medicine Objectives DSM-5
More informationOpioid Agonists. Natural derivatives of opium poppy - Opium - Morphine - Codeine
Natural derivatives of opium poppy - Opium - Morphine - Codeine Opioid Agonists Semi synthetics: Derived from chemicals in opium -Diacetylmorphine Heroin - Hydromorphone Synthetics - Oxycodone Propoxyphene
More informationNALTREXONE DAVID CRABTREE, MD, MPH UNIVERSITY OF UTAH HEALTH, 2018
NALTREXONE DAVID CRABTREE, MD, MPH TREATMENT OF OPIOID USE DISORDER (OUD) Majority of people who develop OUD are not receiving treatment Only a small fraction of patients are offered treatment with medications
More informationBuprenorphine: An Introduction. Sharon Stancliff, MD Harm Reduction Coalition September 2008
Buprenorphine: An Introduction Sharon Stancliff, MD Harm Reduction Coalition September 2008 Objective Participants will be able to: Discuss the role of opioid maintenance in reducing morbidity and mortality
More informationTreatment Alternatives for Substance Use Disorders
Treatment Alternatives for Substance Use Disorders Dean Drosnes, MD, FASAM Associate Medical Director Director, Chronic Pain and SUD Program Caron Treatment Centers 1 Disclosure The speaker has no conflict
More informationBuilding capacity for a CHC response to Ontario's Opioid Crisis
Building capacity for a CHC response to Ontario's Opioid Crisis Rob Boyd Oasis Program Director Luc Cormier, RN, MScN Community Health Nurse Sandy Hill Community Health Centre #AOHC2016 @rboyd6 @SandyHillCHC
More informationOpioid Use Disorder Treatment Initiation in Diverse Settings
Opioid Use Disorder Treatment Initiation in Diverse Settings Sarah Wakeman, MD, FASAM Medical Director, Mass General Substance Use Disorder Initiative Assistant Professor, Harvard Medical School Disclosures
More informationWhat Is Heroin? Examples of Opioids. What Science Says about Opioid Use Disorder and Its Treatment 6/27/2016
What Science Says about Opioid Use Disorder and Its Treatment Perilou Goddard, Ph.D. Department of Psychological Science Northern Kentucky University Examples of Opioids Agonists (activate opioid receptors)
More informationBASIC VOLUME. Elements of Drug Dependence Treatment
BASIC VOLUME Elements of Drug Dependence Treatment Module 3 Principles of CBT and relapse prevention strategies Introduction to Cognitive Behavioural Therapy Basics of pharmacological treatment Workshop
More informationMethamphetamine & Cocaine Use Disorders
Methamphetamine & Cocaine Use Disorders Timothy E. Wilens, MD Director, Center for Addiction Medicine Chief, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital Harvard Medical
More informationEVIDENCE-BASED INTERVENTIONS TO HELP PATIENTS QUIT TOBACCO
EVIDENCE-BASED INTERVENTIONS TO HELP PATIENTS QUIT TOBACCO Lena Matthias Gray, MSA, CTTS-M University of Michigan MHealthy Tobacco Consultation Service Overview of Tobacco Use The World Health Organization
More informationAddiction Medicine: What s new for primary care
Addiction Medicine: What s new for primary care Dan Vinson, MD Family and Community Medicine How to talk so our patients listen, and listen so our patients talk. 1 2 Comfortably engaging your patient in
More informationAddiction Overview. Diane A. Rothon MD. Causes Consequences Treatments. Methadone/Buprenorphine 101 April 1, 2017
Addiction Overview Causes Consequences Treatments Methadone/Buprenorphine 101 April 1, 2017 Diane A. Rothon MD Why? would you listen to this presentation Review the definition and neurobiology of addiction
More informationVarenicline and Other Pharmacotherapies for Tobacco Dependence
Varenicline and Other Pharmacotherapies for Tobacco Dependence J. Taylor Hays, M.D. Associate Director Nicotine Dependence Center Mayo Clinic 2012 MFMER slide-1 Learning Objectives Understand the mechanism
More informationThe available evidence in the field of treatment of opiate: The experience of developing the WHO clinical guidelines
The available evidence in the field of treatment of opiate: The experience of developing the WHO clinical guidelines Background, Objectives and Methods Systematic reviews (SRs) published by Cochrane Drugs
More informationTreating Addiction as a Chronic Disease
Treating Addiction as a Chronic Disease Sarah E. Wakeman, MD, FASAM Medical Director, MGH Substance Use Disorder Initiative Assistant Professor of Medicine, Harvard Medical School Disclosures Neither I
More informationUnderstanding Addiction and Dugs Of Abuse
Understanding Addiction and Dugs Of Abuse Wilkie A. Wilson, Ph.D. DukeLEARN wawilson@duke.edu There is a lot of epidemiological evidence that addiction begins before brain maturity, and lately some biological
More informationMethamphetamine & Cocaine Use Disorders
Methamphetamine & Cocaine Use Disorders Timothy E. Wilens, MD Director, Center for Addiction Medicine Chief, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital Harvard Medical
More informationPHARMACOTHERAPY OF SMOKING CESSATION
PHARMACOTHERAPY OF SMOKING CESSATION Domenic A. Ciraulo, MD Director of Alcohol Pharmacotherapy Research Center for Addiction Medicine Department of Psychiatry Massachusetts General Hospital Disclosure
More informationWanting to Get Pregnant
Continuing Medical Education COPD Case Presentation LEARNING OBJECTIVES Those completing this activity will receive information that should allow them to Assist a patient in developing a quit plan; Advise
More informationMedication-Assisted Treatment (MAT) Overview
Medication-Assisted Treatment (MAT) Overview 2014 Opiate Conference: Don t Get Me Started Hyatt Regency, Columbus, Ohio June 30-July 1, 2014 Christina M. Delos Reyes, MD Medical Consultant, Center for
More informationBrief Intervention for Smoking Cessation. National Training Programme
Brief Intervention for Smoking Cessation National Training Programme Introduction Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about
More informationUMASS TOBACCO TREATMENT SPECIALIST CORE TRAINING
UMASS TOBACCO TREATMENT SPECIALIST CORE TRAINING Course Description Goals and Learning Objectives 55 Lake Ave North, Worcester, MA 01655 www.umassmed.edu/tobacco 1 Table of Contents Determinants of Nicotine
More informationThe causes of misuse:
The Drug Misuse The causes of misuse: Availability of drugs. A vulnerable personality. Adverse social environment. Regular drug taking play a role. Determining misuse and dependence, it is unclear whether
More informationCSAM-SCAM Fundamentals. Cocaine Basics. Presentation provided by David C. Marsh MD CCSAM
CSAM-SCAM Fundamentals Cocaine Basics Presentation provided by David C. Marsh MD CCSAM Chronic Illness Relapsing & Remitting in Course Genetic Predisposition Individual Choice a Factor Environmental Influence
More informationOpioids. October 29, Addiction Medicine Review Course CSAM, Newport Beach, CA
Opioids October 29, 2010 Addiction Medicine Review Course CSAM, Newport Beach, CA Daniel P. Alford, MD, MPH, FACP, FASAM Associate Professor of Medicine Boston University School of Medicine Boston Medical
More informationDrug Addiction Is a Disease So What Do We Do about It?
Lesson 5 Elaborate/ Evaluate Drug Addiction Is a Disease So What Do We Do about It? Photo courtesy of Gray Wolf Ranch Wilderness Recovery Lodge. Overview Students make predictions about the success rate
More informationThe Neurobiology of Addiction
The Neurobiology of Addiction Jodi Gilman, Ph.D. Center for Addiction Medicine Massachusetts General Hospital Associate Professor, Department of Psychiatry Harvard Medical School What is Addiction? commonly
More informationThe Brain, Behavior and Addiction National Family Dialogue January 27, 2010 Presenter: Flo Hilliard, MSH University of Wisconsin-Madison
The Brain, Behavior and Addiction National Family Dialogue January 27, 2010 Presenter: Flo Hilliard, MSH University of Wisconsin-Madison Attitudes about addiction and recovery throughout history Disease?
More informationScientific Facts on. Psychoactive Drugs. Tobacco, Alcohol, and Illicit Substances
page 1/5 Scientific Facts on Psychoactive Drugs Tobacco, Alcohol, and Illicit Substances Source document: WHO (2004) Summary & Details: GreenFacts Context - Psychoactive drugs such as tobacco, alcohol,
More informationHIV and Aging. Making Tobacco Cessation a Priority in HIV/AIDS Services. Objectives. Tobacco Use Among PLWHA
HIV and Aging Making Tobacco Cessation a Priority in HIV/AIDS Services June 27, 2008 Amanda Brown, MPH Ruth Tripp, MPH, RN Objectives To explore existing knowledge of the HIV and smoking connection. To
More informationTreatment Team Approaches in Substance Abuse Treatment
Treatment Team Approaches in Substance Abuse Treatment PLANT A SEED AND WATCH IT GROW 2 Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
More informationThe Opiate Crisis 4/6/18. April 9, Words are important. If you want to care for something, you call it a flower.
The Opiate Crisis Presented by Dr. Anahi Ortiz Franklin County Coroner April 9, 2018 Words are important. If you want to care for something, you call it a flower. If you want to kill something, you call
More informationOpioid Use Disorder Treatment: Buprenorphine Treatment Basics
Opioid Use Disorder Treatment: Buprenorphine Treatment Basics Daniel Warren, MD Eastern Oregon Coordinated Care Organization Provider Forum on Chronic Noncancer Pain Management Pendleton, OR February 24,
More informationMethamphetamine & Cocaine Use Disorders
Methamphetamine & Cocaine Use Disorders Timothy E. Wilens, MD Director, Center for Addiction Medicine Chief, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital Harvard Medical
More informationGUIDELINES FOR THE USE OF PSYCHOACTIVE MEDICATIONS IN INDIVIDUALS WITH CO-OCCURRING SUBSTANCE USE DISORDERS
City and County of San Francisco Mayor Gavin Newsom Department of Public Health Community Behavioral Health Services 1380 Howard Street 5 th Floor San Francisco, CA 94103 GUIDELINES FOR THE USE OF PSYCHOACTIVE
More informationPharmacotherapy for Substance Use Disorders
Pharmacotherapy for Substance Use Disorders Vanessa de la Cruz, MD Chief of Psychiatry Mental Health and Substance Abuse Services Santa Cruz County Health Services Agency 1400 Emeline Avenue Santa Cruz,
More information8/5/2013. MOSBIRT Annual Training The Big change in addiction medicine? Before we dive into pharmacotherapy
Medication Assisted Treatment for Substance Abuse in Primary Care Dan Vinson August 1, 2013 1 The Big change in addiction medicine? These diseases are rapidly becoming medical diseases. Done are the days
More informationMain Questions. Why study addiction? Substance Use Disorders, Part 1 Alecia Schweinsburg, MA Abnromal Psychology, Fall Substance Use Disorders
Substance Use Disorders Main Questions Why study addiction? What is addiction? Why do people become addicted? What do alcohol and drugs do? How do we treat substance use disorders? Why study addiction?
More informationThe role of behavioral interventions in buprenorphine treatment of opioid use disorders
The role of behavioral interventions in buprenorphine treatment of opioid use disorders Roger D. Weiss, MD Harvard Medical School, Boston, MA, McLean Hospital, Belmont, MA, USA Today s talk Review of studies
More informationLong term pharmacotherapy for Alcohol Dependence: Anti Craving agents
Long term pharmacotherapy for Alcohol Dependence: Anti Craving agents Myth or Reality? Complete Recovery means a medication-free state True or False? Treatment of Alcoholism Assessment Motivation Alcohol
More informationManagement of Tobacco Dependence. Dr. Lokesh Kumar Singh Associate Professor Department of Psychiatry AIIMS, Raipur
Management of Tobacco Dependence Dr. Lokesh Kumar Singh Associate Professor Department of Psychiatry AIIMS, Raipur Difficult to identify any other condition that presents such a mix of lethality, prevalence,
More informationC AT E G O R Y I I I COMMUNICATION, TREATMENT & PREVENTION INTERVENTIONS PHARMACOLOGY OF ADDICTIONS
C AT E G O R Y I I I COMMUNICATION, TREATMENT & PREVENTION INTERVENTIONS PHARMACOLOGY OF ADDICTIONS 1.0 Introduction Medications are used in the treatment of drug, alcohol and nicotine dependence to manage
More informationUnit II Problem 7 Pharmacology: Substance Abuse, Dependence and Addiction
Unit II Problem 7 Pharmacology: Substance Abuse, Dependence and Addiction Drugs are classified as being Used (medically approved) abused (medically NOT approved) - What is the difference between dependence
More informationTreating Addiction as a Chronic Illness: Why it is Finally Possible. A. Thomas McLellan Treatment Research Institute
Treating Addiction as a Chronic Illness: Why it is Finally Possible. A. Thomas McLellan Treatment Research Institute 9/29/2014 Treatment Research Research Institute, Institute, 20132012 The End Because
More informationBreaking the Chains of Nicotine Dependence - A Breakthrough Approach
Breaking the Chains of Nicotine Dependence - A Breakthrough Approach Dr Rob Young Senior Lecturer & Consultant Physician Auckland Hospital, New Zealand Smoking Cessation in 2001 Smoking contributes to
More informationPharmacotherapy for Tobacco Dependence Treatment
Pharmacotherapy for Tobacco Dependence Treatment Nancy Rigotti, MD Professor of Medicine, Harvard Medical School Director, Tobacco Research and Treatment Center, Massachusetts General Hospital nrigotti@partners.org
More informationKurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center
Kurt Haspert, MS, CRNP University of Maryland Baltimore Washington Medical Center Data from the National Vital Statistics System Mortality The age-adjusted rate of drug overdose deaths in the United States
More informationObjectives 11/2/2016. Managing Patients with Substance Abuse. Off Label Disclosure. Steven Shoptaw, PhD Professor Department of Family Medicine, UCLA
Managing Patients with Substance Abuse Steven Shoptaw, PhD Professor Department of Family Medicine, UCLA Objectives Epidemiology: Substances most likely to be misused in HIV care settings. Diagnostic and
More informationUnderstanding Alcohol And Other Drugs Of Abuse
Understanding Alcohol And Other Drugs Of Abuse Wilkie A. Wilson, Ph.D. DukeLEARN www.dukelearn.com Duke University Medical Center 1 We teach people to respect their hearts... Exercise Eat good food Reduce
More information2/19/18. Today s talk. Today s talk. The Role of Behavioral Interventions in Buprenorphine Treatment of Opioid Use Disorders
The Role of Behavioral Interventions in Buprenorphine Treatment of Opioid Use Disorders Roger D. Weiss, MD Chief, Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA Professor of Psychiatry,
More informationAppendix F Federation of State Medical Boards
Appendix F Federation of State Medical Boards Model Policy Guidelines for Opioid Addiction Treatment in the Medical Office SECTION I: PREAMBLE The (name of board) recognizes that the prevalence of addiction
More informationTobacco & Nicotine: Addiction and Treatment
Tobacco & Nicotine: Addiction and Treatment Tim McAfee, MD, MPH Chief Medical Officer - Free & Clear 206-876-2551 - tim.mcafee@freeclear.com Affiliate Assistant Professor, University of Washington, School
More informationThe Importance of Psychological Treatment and Behavioral Support
The Importance of Psychological Treatment and Behavioral Support Michael W. Otto, PhD Department of Psychological and Brain Science Boston University Conflicts and Acknowledgements No industry funding
More informationBehavioral Therapies for Methamphetamine Use
Behavioral Therapies for Methamphetamine Use Will M. Aklin, PhD National Institute on Drug Abuse Division of Therapeutics and Medical Consequences June 27, 2017 1 Behavioral Therapy Development Program
More informationDeveloped and Presented by Randall Webber, MPH, CADC JRW Behavioral Health Services
Developed and Presented by Randall Webber, MPH, CADC JRW Behavioral Health Services www.randallwebber.com MAT clients are still addicted Truth: MAT clients will experience withdrawal symptoms if they stop
More informationLONG TERM PHARMACOTHERAPY OF OPIOID DEPENDENCE
LONG TERM PHARMACOTHERAPY OF OPIOID DEPENDENCE DR. SHILPA ADARKAR ASSOCIATE PROFESSOR DEPARTMENT OF PSYCHIATRY & DRUG DEADDICTION CENTRE OF EXCELLENCE SETH GSMC & KEMH LONG TERM OPTIONS FULL AGONIST PARTIAL
More informationLong term treatment for opioid dependence Antagonist therapy
Long term treatment for opioid dependence Antagonist therapy Treatment of Opioid Dependence Antagonist treatment Naltrexone Naltrexone (NTX) synthesized in 1965 Eliminate drug carving and prevent relapse
More informationGOALS AND OBJECTIVES
SUBOXONE AND VIVITROL: ARE THERE DISPARITIES SURFACING IN MEDICATION ASSISTED TREATMENTS? P R E S E N T E D B Y D R. K I AM E M AH A N I A H & D R. M Y E C H I A M I N T E R - J O R D AN GOALS AND OBJECTIVES
More informationSmoking Cessation: Where Are We Now? Nancy Rigotti, MD
Smoking Cessation: Where Are We Now? Nancy Rigotti, MD Director, MGH Tobacco Research and Treatment Center Professor of Medicine, Harvard Medical School nrigotti@partners.org OVERVIEW The challenge for
More informationMEDICATION ASSISTED TREATMENTS (MAT) FOR SUBSTANCE USE DISORDERS
MEDICATION ASSISTED TREATMENTS (MAT) FOR SUBSTANCE USE DISORDERS PHYLLIS RAYNOR, PHD, PMHNP-BC, APRN CLINICAL ASSISTANT PROFESSOR, USC COLLEGE OF NURSING LEARNING OBJECTIVES: Define types of SUD and purposes
More informationModule II Opioids 101 Opiate Opioid
BUPRENORPHINE TREATMENT: A TRAINING FOR MULTIDISCIPLINARY ADDICTION PROFESSIONALS Module II Opioids 101 Module II Goals of the Module This module reviews the following:! Opioid addiction and the brain!
More informationPOLYSUBSTANCE USE IN THE TREATMENT OF OPIOID USE DISORDER WITH BUPRENORPHINE
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences POLYSUBSTANCE USE IN THE TREATMENT OF OPIOID USE DISORDER WITH BUPRENORPHINE MARK DUNCAN, MD November 8, 2018 SPEAKER
More informationArwen Podesta, MD. ABIHM, ABAM, Forensic Psychiatry
The State of Medicine in Addiction Recovery Arwen Podesta, MD ABIHM, ABAM, Forensic Psychiatry www.podestawellness.com 504-252-0026 http://www.addictionpolicy.org/ Overview Addiction is a serious, chronic
More informationV. EVIDENCE-BASED APPROACHES TO TREATING ADOLESCENT SUBSTANCE USE DISORDERS
V. EVIDENCE-BASED APPROACHES TO TREATING ADOLESCENT SUBSTANCE USE DISORDERS R esearch evidence supports the effectiveness of various substance abuse treatment approaches for adolescents. Examples of specific
More informationDiscover the Hope: Opiate Treatment and Recovery
Discover the Hope: Opiate Treatment and Recovery The Continued Struggle to Find and Implement Best Practices Ted Parran JR. M.D. FACP Carter and Isabel Wang Professor of Medical Education CWRU School of
More informationInterdisciplinary Management of Opioid Use Disorder in Rural Primary Care Settings
Interdisciplinary Management of Opioid Use Disorder in Rural Primary Care Settings BRIAN GARVEY, MD, MPH REBECCA CANTONE, MD OREGON HEALTH & SCIENCE UNIVERSITY SCAPPOOSE RURAL HEALTH CENTER Disclosures
More informationWasted AN INTRODUCTION TO SUBSTANCE ABUSE
Wasted AN INTRODUCTION TO SUBSTANCE ABUSE Dr. Brian L. Bethel Child and Family Therapist Independent Trainer and Consultant LPCC-S, LCDC III, RPT-S www.brianlbethel.com INTERPLAY COUNSELING & CONSULTING
More informationAddiction as a Neuropsychiatric Medical Condition
Addiction as a Neuropsychiatric Medical Condition Wilson M. Compton, M.D., M.P.E. Director, Division of Epidemiology, Services and Prevention Research National Institute on Drug Abuse 5 November 2009 Summary
More informationPragmatic and Creative Responses to the Opioid Crisis in Connecticut
Focusing on Highly Vulnerable Populations Track Pragmatic and Creative Responses to the Opioid Crisis in Connecticut A special thanks to our presenting sponsor: Presenters: Shawn Lang Deputy Director AIDS
More information